Childbearing Normal Flashcards by Matt Peisert

Estimated date of birth (confinement) - Nagel’s rule

last day of menstrual period - 3 months + 7 days + 1 year

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Ultrasonography

estimates fetal age from head measurements

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fundal height measurement

from top of symphysis pubis to the top of the fundus

above level of symphysis - 12-14 weeks
at umbilicus (20 cm) - about 20 weeks
rises about 1cm/week until 36 weeks

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Gravada

total number of pregnancies

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Para

number of past pregnancies beyond period of viability (20 weeks, >500 g)

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Term

38-42 weeks

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Chadwick’s sign

bluish color of cervix (probable sign of pregnancy)

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Hegar’s sign

softening and compressibility of isthmus uterus (probable sign of pregnancy)

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Fetal assessment (FHR and movement): Normal

FHR 120-160 at term
Fetal movement - regular pattern of 10 movements in 20 minutes to 2 hrs twice a day
fewer than three movements in a 1 hr period should be reported

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Non-stress test

After 28 weeks records fetal movements and FHR
pt should eat snacks
favorable results is 2 or more FHT accels of 15 bpm lasting 15 seconds over a 20 minute interval

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Contraction stress test

performed at 28 weeks
semi fowlers or side lying
Positive - late decels with at least 50% of contractions - potential risk to fetus; cesarean may be necessary
-Negative - no late decels with minimum of 3 contractions lasting 40-60 seconds in 10 minute period

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TORCH infections: health risks to fetus

Toxoplasmosis
Other: syphilis, Group B strep, Hep B; A, AIDS
Rubella
Cytomegalovirus (from Herpes virus)
Herpes Simplex

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Danger signs of pregnancy

Gush of fluid or bleeding from vagina
Regular uterine contractions
Severe headaches, visual disturbances, abdominal pain, persistent vomiting
Fever or chills
Swelling in face and fingers
...see physician if these occur

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Lightening

descend into pelvis (baby “drops”) - two weeks before delivery

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Cervical changes during labor

Effacement - progressive thinning and shortening of cervix (0 - 100%)
Dilation (0-10cm)
Rupture of membranes - check FHR

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S/Sx of prolapsed cord

symptoms: premature ROM, presenting part not engaged, fetal distress, protruding cord
Nursing care: call for help, push against presenting part to relieve pressure on cord, place in Trendelenburg or knee-chest position
Successful treatment - fetal heart tones remain unchanged

Fetal monitoring: FHR

Normal FHR 120-160

Tachycardia 160 bpm more than 10 minutes -

Fetal tachycardia

FHR > 160 longer than 10 minutes
early sign of fetal hypoxia
associated with maternal fever, fetal anemia, fetal or maternal infection, drugs, maternal hyperthyroidism, fetal heart failure, nonreassuring sign when associated with late decels, severe variable decels, or absence of variability

Fetal bradycardia

FHR <110-120 longer than 10 minutes
late sign of fetal hypoxia
associated with maternal drugs (anesthetics), prolonged cord compression, fetal congenital heart block, maternal supine hypotensive syndrome, nonreassuring sign when associated with loss of variability and late decelerations

Fetal decelerations (early, late, variable)

Early: head compression - benign
Late: fetal hypoxia - deficient placental perfusion
caused by PIH, maternal diabetes, placenta previa, abruption placentae, nonreasurring sign
Variable: more than 15 bpm lasting 15 seconds -return to baseline less than 2 minutes after contraction
ominous if repetitive, prolonged, severe, or slow return to baseline
-administer O2, discontinue oxytocin, move to left side, prep for c-section

Lie

relationship of spine of fetus to spine of mother
Longitudinal - parallel
Transverse - right angles
Oblique - angled

Presentation

Part of fetus that presents to maternal pelvic inlet
Cephalic/vertex - head
Breech - buttocks
-Frank - hips flexed/knees extended
-complete - legs crossed
-footing - one of feet down (may be first part out)
Shoulder

Position

Relationship of fetal reference point to maternal pelvis.
Fetal reference point
-Occiput (o)
-Sacrum (s)
Maternal pelvis is designated right/left (R/L), anterior/posterior (A/P)
LOA most common

Station

Level of presenting part in relation to imaginary line between ischial spines (zero station)

Phases of contractions

Increment - from beginning of contraction until peak Acme/peak -strongest intensity Decrement - diminishing intensity

Characteristics of contractions

Frequency - beginning of one to beginning of next Duration - time in seconds from beginning to end Intensity - strength (mild to strong) subjective or palpation. frequency of less than 2 minutes should be reported - close to delivery Duration greater than 90 seconds reported - stressful for infant (uteran rupture or fetal distress)

4 Stages of labor

1. Beginning of labor to complete cervical dilation (0-10cm) 2. Complete dilation to birth 3. Birth to delivery of placenta 4. first 4 hours after delivery of placenta

First stage of labor: 3 phases

``` phase 1 - latent 0-3 cm contractions 10-30 sec long, 5-30 min apart mild to moderate intensity Phase 2 - active 4-7 cm contractions 30-40 sec long, 3-5 min part mod to strong Phase 3 - transition 8-10 cm contractions 45-90 sec long, 1.5-2 min apart strong ```

Second stage of labor: 3 phases

``` phase 1 0 to +2 station contractions 2-3 min apart phase 2 +2 to +4 station contractions 2-2.5 min apart increase dark read bloody show increased urgency to bear down phase 3 +4 to birth contractions 1-2 min apart; fetal head visible; increased urgency to bear down ```

Fetal distress: irregular HR

turn mother to left side give supplemental O2 check for cord prolapse start IV

Fetal distress: umbilical cord prolapse

elevate presenting part off cord call for help place mother in trendelenburg or knee-bent position O2, IV

Lochia appearance after delivery

``` Drainage from vagina Day 1-3: Rubra - bloody Day 4-9: Serosa - pink-brown Day 10+: Alba - yellow-white Foul odor indicates infection at any time ```

When is RhoGAM indicated?

Rh positive fetus and Rh negative mother | Give before mother develops antibodies against fetal blood